Boston—Deaths from cardiovascular disease (CVD) in the U.S. increased substantially during the first year of the COVID-19 pandemic, according to a new study.

The report in the journal Circulation noted that the number of CVD-related deaths rose from 874,613 in 2019 to 928,741 in 2020. The American Heart Association (AHA) Statistical Update 2023 pointed out that 2019 to 2020 was the greatest single-year increase since 2015 and exceeded the previous high of 910,000 recorded in 2003.

“While the total number of CVD-related deaths increased from 2019 to 2020, what may be even more telling is that our age-adjusted mortality rate increased for the first time in many years and by a fairly substantial 4.6%,” said the volunteer chair of the Statistical Update writing group Connie W. Tsao, MD, MPH, an assistant professor of medicine at Harvard Medical School and attending staff cardiologist at Beth Israel Deaconess Medical Center in Boston. “The age-adjusted mortality rate takes into consideration that the total population may have more older adults from one year to another, in which case you might expect higher rates of death among older people. So even though our total number of deaths have been slowly increasing over the past decade, we have seen a decline each year in our age-adjusted rates—until 2020. I think that is very indicative of what has been going on within our country—and the world—in light of people of all ages being impacted by the COVID-19 pandemic, especially before vaccines were available to slow the spread.”

The largest increases in CVD deaths occurred in Asian, black, and Hispanic patients. The authors noted that those groups also were strongly affected by COVID-19 in the early outbreaks.

“We know that COVID-19 took a tremendous toll, and preliminary data from the U.S. Centers for Disease Control and Prevention (CDC) have shown that there was a substantial increase in the loss of lives from all causes since the start of the pandemic. That this likely translated to an increase in overall cardiovascular deaths, while disheartening, is not surprising. In fact, the Association predicted this trend, which is now official,” said the AHA volunteer president, Michelle A. Albert, MD, MPH, of the University of California at San Francisco (UCSF) and Admissions Dean for UCSF Medical School. “COVID-19 has both direct and indirect impacts on cardiovascular health. As we learned, the virus is associated with new clotting and inflammation. We also know that many people who had new or existing heart disease and stroke symptoms were reluctant to seek medical care, particularly in the early days of the pandemic. This resulted in people presenting with more advanced stages of cardiovascular conditions and needing more acute or urgent treatment for what may have been manageable chronic conditions. And, sadly, appears to have cost many their lives.”

The statistical update looks at the trend of overall CVD-related deaths globally and regionally. The authors pointed out that globally, ischemic heart disease and stroke are the top two causes of CVD-related deaths and account for 16.2% and 11.6% of all causes of death, respectively. North America and Europe/Central Asia are the only regions where rates have increased over the last decade.

Specifically, in 1990, ischemic heart disease represented 28.2% of all deaths in North America, dropping to 18.7% of all deaths in 2019. Stroke dropped from 7.3% of all deaths in North America in 1990 to 6.4% of all deaths in 2019.

This statistical update was created by a volunteer writing group on behalf of the AHA Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee.

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